• Gynecological tumor
• High buttocks supine position
• IMRT
• Small bowel

• Humans
• Female
• Intestine, Small/radiation effects
• Supine Position
• Radiotherapy, Intensity-Modulated/methods
• Radiotherapy, Intensity-Modulated/adverse effects
• Middle Aged
• Genital Neoplasms, Female/radiotherapy
• Buttocks/radiation effects
• Adult
• Organs at Risk/radiation effects
• Aged
• Patient Positioning
• Radiotherapy Dosage
• Radiotherapy Planning, Computer-Assisted/methods
• Tomography, X-Ray Computed
• Radiation Injuries/prevention & control
• Radiation Injuries/etiology

In theory, the hyperfractionated radiotherapy can enhance biological effect dose against tumor and alleviate normal tissue toxicity. This study is to assess the efficacy and safety of preoperative hyperfractionated intensity-modulated radiotherapy (IMRT) with oral capecitabine in patients with locally advanced rectal cancer (LARC).

We retrospectively screened patients with LARC from January 2015 to June 2016. Patients that received hyperfractionated IMRT or conventional fractionated IMRT were eligible in the hyperfractionation (HF) group or conventional fractionation (CF) group, respectively. The primary outcome was the complete response rate. Secondary outcomes included toxicity, postoperative complications, anus-reservation operation rate, local recurrence and distant metastases rate, overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).

335 patients were included in the analysis. The complete response rate for the hyperfractionated and conventional fractionated IMRT was 20.41% vs. 23.47% (P = 0.583). The anus-reservation operation rate was 68.37% vs. 65.31% (P = 0.649). There were no cases of grade 4 toxicity during radiotherapy; the rate of grade 3 toxicity and postoperative complications was both comparable between groups. However, in the CF group, more patients had a second operation due to complications (0.0% vs. 5.68%, P = 0.011). The cumulative local regional recurrence and distant metastases rates of the HF group and CF group were 5.10% vs. 9.18% (P = 0.267) and 22.45% vs. 24.49% (P = 0.736), respectively. The 5-year OS, CSS, and DFS in the HF group and CF group were 86.45% vs. 73.30% (P = 0.503), 87.34% vs. 75.23% (P = 0.634), and 70.80% vs. 68.11% (P = 0.891), respectively.

The preoperative hyperfractionated IMRT with oral capecitabine, with an acceptable toxicity and favorable response and survival, could reduce the rate of secondary surgery.

• Cancer du rectum
• Intestin grêle
• Positioning
• Positionnement
• Radiotherapy
• Radiothérapie
• Rectal cancer
• Small bowel

• Bellyboard
• Gynaecological radiotherapy
• Pelvis
• Prone position
• Rectum
• Small bowel
• Supine position

To compare organ-at-risk doses and setup reproducibility using the prone and supine orientations in volumetric modulated arc therapy (VMAT) for rectal cancer.

Seventeen consecutive rectal cancer patients undergoing preoperative radiation were selected and setup in either the prone (N = 8) or supine (N = 9) position. All patients were treated using posteriorly-applied VMAT. Bladder and small bowel dose and cone beam CT (CBCT) reproducibility metrics were retrospectively collected.

Dose metrics for bladder and small bowel did not show significant differences between the prone and supine orientations. The prone data had a trend for smaller irradiated volumes than supine for the small bowel at lower doses—V20 (prone: 135 ± 99 cm³; supine: 201 ± 162 cm³) and V30 (prone: 78 ± 71 cm³; supine: 105 ± 106 cm³). At higher doses, the trend reversed as exemplified by the small bowel V50.4 (prone: 20 ± 28 cm³; supine: 10 ± 14 cm³). CBCT data showed that rotational errors in pitch and roll were significantly larger for the prone vs. supine orientation (pitch: 2.0° ± 1.3° vs. 0.8° ± 1.1° p < 0.001; roll: 1.0° ± 0.9° vs. 0.3° ± 0.5°, p < 0.001).

Bladder and small bowel doses were not significantly different when comparing VMAT plans developed for the prone and supine orientations. The supine orientation demonstrated improved setup reproducibility.

• CBCT
• Prone
• Rectal cancer
• Supine
• VMAT

We recently developed a novel, open-source in vivo dosimetry that uses the electronic portal imaging device to detect dose delivery discrepancies. We applied our method on patients with rectal cancer treated on a belly board device.

In vivo dosimetry was performed on 10 patients with rectal cancer treated prone on the belly board with a 4-field box arrangement. Portal images were acquired approximately once per week from each treatment beam. Our dosimetry method used these images along with the planning CT to reconstruct patient planar dose at isocenter depth.

Our algorithm proved sensitive to dose discrepancies and detected discordances in 7 patients. The majority of these were due to soft tissue differences between planning and treatment, present despite matching to bony anatomy. As a result of this work, quality assurance procedures have been implemented for our immobilization devices.

In vivo dosimetry is a powerful quality assurance tool that can detect delivery discrepancies, including changes in patient setup and position. The added information on actual dose delivery may be used to evaluate equipment and process quality and to guide for adaptive radiotherapy.

• EPID dosimetry
• adaptive radiotherapy
• belly board device
• in vivo dosimetry
• patient safety

To report the results of a prospective study that compares small bowel doses during prone and supine pelvic intensity modulated radiation therapy.

Ten patients receiving pelvic radiation therapy each had 2 intensity modulated radiation therapy plans generated: supine and prone on a belly board (PBB). Computed tomography on rails was performed weekly throughout treatment in both positions (10 scans per patient). After image fusion, doses to small bowel (SB) loops and clinical target volume were calculated for each scan. Changes between the planned and received doses were analyzed and compared between positions. The impact of bladder filling on SB dose was also assessed.

Prone treatment was associated with significantly lower volumes of SB receiving ≥20 Gy. On average, prone on a belly board positioning reduced the volume of SB receiving a given dose of radiation by 28% compared with supine positioning. Target coverage throughout the treatment course was similar in both positions with an average minimum clinical target volume dose of 88% of the prescribed prone dose and 89% of the supine (P = .54). For supine treatment, SB dose was inversely correlated with bladder filling (P = .001-.013; P > .15 for prone). For 96% of treatments, the volume of SB that received a given dose deviated >10% from the plan. The deviation between the planned and delivered doses to SB did not differ significantly between the positions.

Prone positioning on a belly board during pelvic IMRT consistently reduces the volume of SB that receives a broad range of radiation doses. Prone IMRT is associated with interfraction dose variation to SB that is similar to that of supine positioning. These findings suggest that prone positioning with daily image guided radiation therapy is an effective method for maximizing SB sparing during pelvic IMRT.

• Dose Fractionation, Radiation
• Humans
• Intestine, Small/radiation effects
• Movement
• Organ Sparing Treatments
• Patient Positioning
• Prone Position
• Prospective Studies
• Radiation Injuries/etiology
• Radiation Injuries/prevention & control
• Radiotherapy, Intensity-Modulated/methods
• Rectal Neoplasms/radiotherapy
• Rectum/physiology
• Supine Position

AIM: To investigate the role of triamcinolone in the management of acute and chronic enteritis caused by pelvic radiotherapy.

METHODS: Twenty-eight patients with rectum adenocarcinoma or endometrium adenocarcinoma were studied. We compared the results of 14 patients treated with injected triamcinolone acetonide (TA) with those of 14 patients who were not treated with TA. For the TA group, 40 mg of TA was injected intramuscularly on the 1^st, 11^th and 21^st d of radiotherapy; the control group received no injections. All of the study participants had a median age of 65 years, had undergone postoperative radiotherapy and were evaluated weekly using Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer Acute Morbidity Score Criteria, and complete blood counts for every 10 d.

RESULTS: Triamcinolone was found to effectively prevent and treat radiation-induced acute gastrointestinal (enteritis) and genitourinary (cystitis) side effects (P = 0.022 and P = 0.023). For the lower GI side effect follow up, 11 patients in the control group had Grade 2 toxicity and 3 patients had Grade 1 toxicity. In the TA group, 5 patients had Grade 2 toxicity and 9 patients had Grade 1 toxicity. For the genitourinary system side effect follow up, 4 patients had Grade 2 toxicity and 6 patients had Grade 1 toxicity. Additionally, 2 patients had Grade 2 toxicity and 2 patients had Grade 1 toxicity. The neutrophil counts did not differ between the TA group and the control group. There was no meaningful difference between age groups and primary cancers. At the 12^th mo of follow up, there were no differences between groups for chronic side effects.

CONCLUSION: Triamcinolone is a moderately potent steroid, that is inexpensive and has a good safety profile. It would be beneficial for reducing medical expenses related to treatment of radiation induced enteritis.

• Radiotherapy
• Enteritis
• Cystitis
• Triamcinolone

• Adenocarcinoma/complications
• Adenocarcinoma/radiotherapy
• Aged
• Anti-Inflammatory Agents/therapeutic use
• Combined Modality Therapy/methods
• Cystitis/drug therapy
• Cystitis/etiology
• Enteritis/etiology
• Female
• Humans
• Male
• Middle Aged
• Postoperative Period
• Radiation Injuries/drug therapy
• Radiotherapy Dosage
• Radiotherapy, Intensity-Modulated/adverse effects
• Rectal Neoplasms/complications
• Rectal Neoplasms/radiotherapy
• Triamcinolone Acetonide/therapeutic use

• Humans
• Intestine, Small/radiation effects
• Morbidity
• Pelvic Neoplasms/epidemiology
• Pelvic Neoplasms/radiotherapy
• Prone Position
• Radiotherapy, Conformal/adverse effects
• Radiotherapy, Conformal/instrumentation
• Radiotherapy, Intensity-Modulated/adverse effects
• Radiotherapy, Intensity-Modulated/instrumentation
• Supine Position

• Female
• Humans
• Intestines/radiation effects
• Magnetic Resonance Imaging
• Male
• Patient Positioning
• Prone Position
• Radiation Dosage
• Radiation Protection/methods
• Radiometry
• Radiotherapy Dosage
• Radiotherapy, Intensity-Modulated/methods
• Rectal Neoplasms/radiotherapy
• Supine Position

although preoperative RT (Radiation Therapy) is becoming the preferred approach for combined treatment of locally advanced rectal adenocarcinoma, no regimen can be now considered as a standard. Since the toxicity of preoperative RT isn't yet completely known, and the advantages of preoperative RT could be counterbalanced by increased postoperative morbidity and mortality, a monocentre series of preoperative bifractionated accelerated RT was retrospectively reviewed to clarify toxicity and outcomes after a prolonged follow up.

patients were screened following these eligibility criteria: histology-proven adenocarcinoma of the rectum; distal tumour extent at 12 cm or less from the anal verge; clinical stage T3–4/anyN, or anyT/N1–2; ECOG Performance Status 0–2. A total dose of 41.6 Gy (26 twice daily fractions of 1.6 Gy) was delivered. Surgery was carried out 17 ± 2 days after RT completion, adopting the total mesorectal excision technique.

24 men and 23 women were enrolled; median age was 55 years (r.: 39–77). Twenty-eight patients were stage II and 19 stage III. 9 patients suffered from a recurrent tumour. 2 patients experienced a severe grade 4 gastrointestinal toxicity (a colo-vaginal fistula and an intestinal obstruction, both successfully treated). Operative mortality was nil; postoperative early complications occurred in 13 cases; mean length of hospital stay was 15 days. After a mean follow up of 44 months (r.: 18–84) 8 patients had deceased for recurrent disease, 15 were alive with a disease progression (2 pelvic recurrences and 13 pure distant deposits) and 24 were alive, without disease. The 5-year actuarial overall survival was 74.2%, the disease-free survival 62.9% and the regional control rate 84.7%. Long-term complications included 1 case of radiation enteritis requiring surgery, 2 cases of anastomotic stricture and 3 cases of bladder incontinence.

bifractionated accelerated RT administered in the preoperative setting to patients bearing locally advanced rectal cancer is reliable and safe, as its immediate and late toxicity (mainly infectious) is acceptably low and long-term survivals are achievable. These findings support the increasing use of preoperative RT for treatment of this malignancy in experienced centres. Ongoing multicentric trials are expected to address still unsolved issues, including the benefit of CT adjunct to preoperative RT.

• Adult
• Aged
• Female
• Humans
• Intestine, Small
• Male
• Middle Aged
• Preoperative Care
• Radiotherapy Dosage
• Radiotherapy, Intensity-Modulated/instrumentation
• Radiotherapy, Intensity-Modulated/methods
• Rectal Neoplasms/radiotherapy
• Tomography, X-Ray Computed

• Chemotherapy, Adjuvant/adverse effects
• Diarrhea/chemically induced
• Hemorrhage/chemically induced
• Humans
• Intestinal Diseases/chemically induced
• Intestinal Obstruction/chemically induced
• Intestine, Small/drug effects
• Intestine, Small/pathology
• Rectal Neoplasms/drug therapy
• Rectal Neoplasms/pathology

• Adult
• Aged
• Drinking
• Female
• Humans
• Intestine, Small/anatomy & histology
• Intestine, Small/diagnostic imaging
• Male
• Middle Aged
• Prospective Studies
• Radiation Dosage
• Radiotherapy Planning, Computer-Assisted
• Rectal Neoplasms/diagnostic imaging
• Rectal Neoplasms/radiotherapy
• Statistics, Nonparametric
• Tomography, X-Ray Computed/instrumentation
• Urinary Bladder/anatomy & histology
• Urinary Bladder/diagnostic imaging
• Urination